Healthcare Provider Details

I. General information

NPI: 1316917040
Provider Name (Legal Business Name): OHIO CANCER SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 ASPIRA CT
MANSFIELD OH
44906-4125
US

IV. Provider business mailing address

1125 ASPIRA CT
MANSFIELD OH
44906-4125
US

V. Phone/Fax

Practice location:
  • Phone: 419-756-2122
  • Fax: 419-756-3530
Mailing address:
  • Phone: 419-756-2122
  • Fax: 419-756-3530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DONALD LEE DEWALD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 419-756-2122